An Evidence-Based Program

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2023 Teen Pregnancy Prevention (TPP) Tier 1 Toolkit

The Office of Population Affairs has released the following Cooperative agreement, Advancing Equity in Adolescent Health through Evidence-Based Teen Pregnancy Prevention Programs and Services (Tier 1). Submission deadline is April 18, 2023.

We will be updating the tool kit as necessary.


Healthy Futures Nu-CULTURE was found effective at increasing the percentage of adolescents that delay the initiation of sexual. The study concluded that the program delayed sexual initiation for girls and for Hispanic populations. Empowering youth to delay the onset of sexual activity improves health equity and sexual reproductive health outcomes by:

  • reducing the chances of a pregnancy early in adolescence1
  • reducing the chances of STI infection

Rotz, Dana, Brian Goesling, Nicholas Redel, Menbere Shiferaw, and Claire Smither-Wulsin (2020). Assessing the Benefits of Delayed Sexual Activity: A Synthesis of the Literature. OPRE Report 2020-04, Washington, DC: Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.

For the full report about the benefits of delayed sexual activity, click here.

For the full impact study about the Healthy Futures program, click here.

Healthy Futures Nu-CULTURE (HFNC) deploys positive youth development strategies throughout each year of the program.

HFNC includes PYD strategies at every level of the program. In addition to the strategies such as positive connections with supportive adults, self-regulation and self-control, planning and decision making, developing a sense of purpose and practicing a healthy lifestyle addressed in the core components of the curriculum, community wide PYD strategies create system wide change. Recommended community wide PYD strategies for system wide change can be found by clicking here.

Click here to review the PYD strategies in HFNC by grade level

Program Content and Outcomes

Core Components

  • Incorporating the message “The choices you make now affect you later!”
  • Implement 24 50-minute lessons over 3 three years to 6th, 7th, and 8th grade students.
  • Building participants’ skills and self-efficacy to effectively weigh the benefits and consequences of their choices.
  • Incorporating activities that increase knowledge and influence positive attitudes, beliefs and self-efficacy to prepare teens for making healthy choices regarding relationships and sexual activity
  • Using age appropriate and medically accurate materials and activities
  • Delivering high quality, participatory, and interactive sessions.
  • Engaging parents and guardians via distribution of daily Parent/Trusted Adult Connection forms.


Program Approach

  • HFNC uses a strengths-based approach to motivate adolescents to embrace the developmentally appropriate truth that “The choices you make NOW affect you LATER!” Engaging youth throughout the program with interactive activities, competitions, and games inspire youth to create a strong sense of individual agency.
  • Youth develop their purpose and mission, clarify individual goals for academics, healthy relationships with peers, intimate partners, and families. The program uses a spiral design that introduces concepts initially in the 6th grade, that expands the content appropriately as youth mature in the 7th and 8th Parents, caregivers, and other trusted adults receive a Parent/Trusted Adult Connect form highlighting each lesson. All Parent/Trusted Adult Connect forms provide talking tips useful for parents and caregivers to expand and reinforce the critical conversations with their teen.
  • The approach includes delivering 24 fifty-minute lessons from the 6th-8th Each grade level receives 8 lesson per year. Each lesson includes a Parent/Trusted Adult Connection form. Click on the links below to review the scope and sequence of each grade.


Core Content


Delayed onset of sexual activity supports health equity because sexual delay is linked to health outcomes that increase mental wellness and academic success including completion of high school.2

2Rotz, Dana, Brian Goesling, Nicholas Redel, Menbere Shiferaw, and Claire Smither-Wulsin (2020). Assessing the Benefits of Delayed Sexual Activity: A Synthesis of the Literature. OPRE Report 2020-04, Washington, DC: Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.

Office of Population Affairs Expects Funded Projects to:

For over twenty years, HFNC has served multiple populations including those communities and youth who face significant needs and who have systemic disparities. Rhea Gordon, the developer of the program, was the foster parent for over 35 youth. This keen insight into the needs of youth who have experienced significant trauma and loss supported the development of an effective program for ALL youth. HFNC is successfully implemented in diverse communities experiencing health disparities and high levels of adolescent pregnancy including African American, Hispanic and Tribal communities.

The Healthy Futures team incudes staff and trainers with expertise in subject matter, needs assessment evaluation and cultural literacy. During your planning period you will receive consultation and expertise to guide your community in the planning process. Specifically, the experts at Healthy Futures assist planning teams to design questioning routes, interviews protocols and strategies to inform the needs assessment and EBP final determination. Our subject matter and evaluation experts provide valuable proficiency in working with community partners to implement and scale the program across multiple settings.

The program theory supporting HFNC include a core component for engaging parents and care givers in critical conversations about sex and relationships. Each lesson includes a parent/trusted adult connection form. A three-year research study found that the program significantly increased communication between parents/caregivers and their teens. Specifically, findings include:

  • HF students who returned sixth grade parent connection forms reported significantly greater communication with parents about sex
  • Communication about specific sexual health topics increased between the sixth-grade pre-test and seventh-grade posttest for:
    • abstinence – 50% to 59% (HF) vs. 49% to 57% (control);
    • condoms – 37% to 53% (HF) vs. 35% to 48% (control); and
    • ways to prevent pregnancy – 51% to 60% (HF) vs. 50% to 58% (control)3

The full study can be viewed in the link below and includes the citation for the study.

3Flaherty, K., Gordon, R., Chow, W., & Vehige- Calise, T. (2015). Effect of a School-Based Teen Pregnancy Prevention Program: Bridging the Gap in Parent-Teen Communication. Poster by JSI Research & Training Institute, Boston, MA.

Parent Communication Study: Healthy Futures significantly increases parent/child communication about sex

HFNC was recently updated in 2023. The program builds an inclusive environment creating equitable access to resources and opportunities for all. It helps individuals and groups feel safe, respected, engaged, and valued for who they are in project materials, practices and services. The program does not discriminate, alienate, exclude or stigmatize youth and their families.


All facilitators who implement HFNC are trained using a culturally responsive framework. This strategy begins with humility and validates the lived experiences of those who have suffered from issues contributing to health disparity.


The specific inclusive health communication4-6 updates in HFNU 2.0 include:


  • Positive and supportive health communication- Uses person-first language, e.g., people who experience….
  • Includes diverse scenarios appropriate for all relationships (LGBTQI) and role plays and preferred terms (they/them)
  • Communication that is supportive and truthful when youth express experiences about gender and gender exploration
  • Validation, affirmation and empathy for the struggle of adolescence and everyone’s unique journey.
  • Provides referrals to school and community resources
  • Starts with mindfulness, listening and joint decision making with shared responsibility of outcomes.
  • Provides alternative activities and referrals where appropriate
  • HFNC is upfront about the lens used to teach the puberty lessons. A scientific biological perspective is used for lessons about anatomy, biology and reproduction. Communities can choose to expand information that includes gender theories as desired and approved by local governing boards and districts.

HFNU 2.0 Updates include trauma informed strategies such as:


  • Creating Safe Spaces Guide in the introduction
  • Calendar recommendation describing lesson content for the eight sessions to share with participants and their parents/trusted adults before content is covered.
  • All session overviews highlight areas in the curriculum that are potentially triggering
  • Updated training materials in the certification training for facilitators and teachers who implement HFNC

4Centers for Disease Control (Aug. 2022) Health Equity Guiding Principals.

5Terhune, Respault, & Conlin. (Oct.6, 2022). Part 1: A Darth of Science. As more transgender children seek medical care, families confront many unknowns.

6World Professional Association for Transgender Health. (2023). Standards of Care for the Health of Transgender and Gender Diverse People, V.8.

To watch a recent webinar about the updates in Healthy Futures 2.0, click here.

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